It happens several times every week. Someone calls, asking for advice as they try to transition mom or dad to an assisted living facility (ALF) or a nursing home.

Most of my 40 years of pastoral service have been with older adults. However, never has there been a time in my ministry when I have had so many inquiries from adult children as now.

It seems nearly everyone I meet is wrestling with issues that pertain to their elderly parents or grandparents.

To sum it up: the roles are now reversed, and the adult children have become parents to their own moms and dads, roles they are not accustomed to taking.

These days, I can certainly identify with others who are assuming this role as parent to a parent. My father recently celebrated his 91st birthday. Since I live 500 miles away, I called to wish him a happy birthday. He told me about his big party, but then his voice dropped, barely above a whisper, as he confessed, "I had to use a cane in order to make it to Sunday School and church this morning."

Dad shared that he had fallen in the basement when his right knee buckled without warning, hence the necessity of a cane. So, as much as he hates to admit it, there are changes looming on the horizon and we, as his children (I am the oldest of 10) will need to assume more responsibilities as we look to the future and make decisions about how to care for him.

My father is among a group that sociologists call, "the oldest old," or those over the age of 85. This group, according to The President's Council on Bioethics Report (September 2005) has approximately 4.5 million people of which only 5 percent are fully mobile, and 50 percent are cognitively impaired.

Whenever families call, asking for advice on helping their parents, I try to help by offering the following advice:

Start "The Move" conversation early on and use good communication skills. Be careful about using "shoulds" or "musts." Choose open-ended questions that foster discussion. You might say, "Mom (or Dad), how are you doing with the housework? Do you feel you are keeping up with it?" Or, "If something happens to you, like the neighbor down the street who fell and broke his hip, where do you want to go?" Ask for their opinion and seek ideas from them. If the parent shows signs of "warming up" to the idea of moving, emphasize the parent's right to self-determination.

The way in which you communicate with your parent(s) is very important. If the parents resist the idea of moving, you may have to wait until things get worse before they will consent to a change. Sometimes it takes a crisis, a severe fall or other health incident, before a parent will consent to a change. Keep the dialogue open and keep talking with them, as well as with the other siblings.

In the absence of a big crisis, be observant of signs that indicate deterioration in their ability to maintain their independence. Be concerned if you see some or all of the following:

•  Unexplained dents and damage to the car.
•  Bruises or cuts on his or her body from falls they have tried to keep from you.
•  Food that is spoiling in the fridge, even when they tell you they are eating well.
•  Wearing the same clothes multiple times when you visit them.
•  The yard looks uncared for and the grass gets too high before mowing. Home repairs go unattended.
•  Bills unpaid because the parent forgot to send in the payments.
•  Unable to take medications properly.
•  Hearing strange noises in the night.
•  Inability to respond to an emergency appropriately.
•  Missing appointments or showing up at church at the wrong time.

Care Team
As we increasingly assume more responsibility for our parents, it is imperative that the family is called, and prayerfully organize a care team. Among the things that need care are:

Deciding who will have the Power of Attorney (POA) or Durable POA and who will make the critical health and business decisions.
 

•  Arranging for meals and trips to the grocery
•  Making appointments with physicians and deciding who will accompany them.
•  Coordinating home health visits.
•  Appointing someone to pay bills and transact necessary business.
•  Setting up a housecleaning and laundry schedule
•  Calling the pharmacy and arranging for meds to be delivered on time.
•  Deciding how to handle unwanted telephone or door-to-door solicitors.

Unfortunately, these chores often fall to the females: daughters, sisters, daughters-in-law, and sometimes grandchildren. Quite often, these same caregivers are trying to work outside their own homes and care for the needs of their primary families too. Care must be taken to assure that caregivers are not overwhelmed.

When the services and support for "living at home" have come to an end, and those who are giving care cannot continue, then the transition to an ALF or nursing home must begin.

When making a decision about the best facility for your parents, keep in mind there are laws in place that may prohibit your parent going into an assisted living facility. If they have a certain degree of dementia and cannot maintain an independent lifestyle, they may not fit the criteria for acceptance into an ALF.

When looking for a good nursing facility for your parent, you will need to ask questions and check out the following:

•  If in the U.S., is the nursing facility Medicare certified?
•  Do they have the level of care needed for your parents?
•  Are they offering a specialty care service?
•  What medical care, equipment, and facilities do they have for emergencies?
•  Is the location close to friends and family so it is easy to visit?
•  Do they offer spiritual support or provide regular worship services?
•  How do the tenants look? Are they clean and dressed appropriately?
•  Does the facility look clean?
•  Does the staff look professional? How do they interact with the tenants?
•  Is there a continuous education program in place for the nurses?

After a decision has been made and the day comes for the transfer of your parent into the new facility, be aware that feelings of "guilt" may overwhelm the entire family. Making this transition may be the most loving thing you can do for your parents as you try to keep the Fifth Commandment, "Honor your father and your mother (Exodus 20:12). The probability is good that you will be treated (by your children) in the same way you have treated your parents. And remember, the grandchildren are watching!

Dennis L. Apple is an associate pastor focusing on senior adults at College Church of the Nazarene in Olathe, Kansas. He is the author of Life After the Death of My Son: What I'm Learning, available at www.nph.com.

Holiness Today, Jan/Feb 2012

Please note: This article was originally published in 2012. All facts, figures, and titles were accurate to the best of our knowledge at that time but may have since changed.